CHYLOTHORAX is produced by interruption of the thoracic duct above the aortic hiatus with fistulous communication into a thoracic space. Such a condition is serious and will prove fatal in a high percentage of cases unless adequate treatment is instituted. A review of medical literature suggests considerable variation in opinion as to clinical management of this complication.
Etiology: Chylothorax is usually produced by direct trauma to the thoracic duct. Until recently the chief offenders have been penetrating wounds inflicted by bullet, steel fragment or knife. Fractures of the vertebral column and severe compression injuries of the thorax have resulted in interruption of the duct. Neoplasms involving the posterior mediastinum may be capable of producing chylothorax; care must be taken, however, to distinguish between chyle and a chyliform effusion. In recent years an increasing number of surgical procedures have been employed involving the posterior mediastinum; splanch-nicectomy, esophagectomy and mediastinotomy in vascular surgery have become commonplace. Surgical injuries to the thoracic duct in these procedures are now recognized as the principal cause of chylothorax.
Anatomy: (Figure 1) The thoracic duct arises from the cisterna chyli at the level of the second lumbar vertebra and enters the posterior mediastinum through the aortic hiatus. The structure rests on the anterior surface of the vertebral column, usually to the right of the midline, and is intimate with the azygos vein and splanchnic nerves. Whereas variations of the thoracic duct are common, the structure usually consists of a single trunk with paired intercostal branches capable of. . .